Twin Peaks Chapter - Online Request Form

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Online Request Form

Online Request for Funding Questionnaire

Indicates required field

Person's name submitting this form
Email of person submitting this form
Recipient type
Name of Recipient
Address of Recipient
Recipient City
State
Recipient ZIP
Type of need (Select one)
Activity type (Fund Raising, Hands-on)
If Hands-on is Prefunding needed? (Y/N)
Proposed Activity Date (mm/dd/yyyy)
Activity Name
Describe the activity in detail and location.
If Fund Raiser, Estimate the expected funds to be raised (Round to nearest dollar)
Estimate volunteer hours to be contributed
Describe the purpose for which funds will be used (such as painting and making repairs, medical expenses, etc)
Estimated cost of Hands-on activity OR estimated funds that will be raised (round to nearest dollar)
Total requested amount from Thrivent Financial. Includes pre-funding amount if applicable. Pre-funding is available for hands-on service activities only. Round to nearest dollar.
Estimated number of Thrivent member households actively involved in planning, preparing for or working at the activity. Must be at least six member household to qualify for supplemental funds.
Community Service Team Members
Are you requesting funds from other chapters or cohosting this activity with another organization? (Y/N)
If yes, please list chapter name(s)/organization(s)
Is the recipient aware they need to sign the Permission to Disclose Information form? (Y/N)
Name of Community Service team contact (first, middle, last)
Service Team Contact's Address
Service Team Contact's City
Service Team Contact's State
Service Team Contact's ZIP
Service Team Contact's telephone (xxx-xxx-xxxx)
Service Team Contact's E-mail adddress
Further comments
Your Email Address

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Appleton Office:
4321 N. Ballard Road
Appleton, WI 54919-0001 USA

Minneapolis Office:
625 Fourth Avenue S.
Minneapolis, MN 55415-1624 USA

Insurance products issued or offered by Thrivent Financial for Lutherans, Appleton, WI. Not all products are available in all states. Products issued by Thrivent Financial for Lutherans are available to applicants who meet membership, insurability, U.S. citizenship and residency requirements. Securities and investment advisory services are offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 55415, a FINRA and SIPC member and a wholly owned subsidiary of Thrivent Financial for Lutherans. Thrivent Financial representatives are registered representatives of Thrivent Investment Management Inc. They are also licensed insurance agents of Thrivent Financial.